Combined Excise Tax Return Form - May 2001
ADVERTISEMENT
1
2
3
4State of Washington
05
Department of Revenue
MAY 2001
PO Box 34051
Seattle, WA 98124-1051
01
COMBINED EXCISE TAX RETURN
ONLY Fill in Box if Amended/Supplemental Return Information is Attached
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
➲
➲
Filing electronically? Only fill in this box ❒ ❒ ❒ ❒ and Total Amount Owed.
Address Changes?
business location
mailing address
both
Business closed?
Date closed ____/____/____
See note 5, page 2.
Please fill in the appropriate box and make address changes to the above label.
I STATE BUSINESS AND OCCUPATION TAX
Line
Column I
Col. 2 Deductions*
Column 3
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 3 & 4
Taxable Amount
Rate
Tax Due
1
Extracting, Extracting for Hire
16
.00484
Slaughter, Break Proc, Perish Meat-Whlse; Mfg Wheat
2
30
.00138
into Flour; Raw Seafood; Soybean & Canola Proc
Travel Agent Com; Intl Charter Freight Brokers;
3
28
.00275
Stevedoring
4
Insurance Agents; Insurance Brokers Commis
14
.00484
5
Manuf Fresh Fruit and Veg; Split or Proc Dried Peas
21
.00138
6
Processing for Hire; Printing and Publishing
10
.00484
7
Manufacturing
07
.00484
8
Royalties; Child Care
80
.00484
9
03
.00484
Wholesaling
Warehousing; Radio & TV Broadcasting; Public Road
10
11
.00484
Construction; Government Contracting
11
Public or Nonprofit Hospitals
55
.015
Cleanup of Radioactive Waste for US Gov’t;
12
83
.00471
Environmental Remedial Action
13
04
.015
Service & Other Activities
14
Retailing of Interstate Transportation Equip
19
.00484
15
Retailing
02
.00471
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
TOTAL B&O TAX
GROSS AMOUNTS FOR RETAILING AND
II STATE SALES AND USE TAX
RETAIL SALES MUST BE THE SAME
16
Retail Sales (also complete local tax section III)
01
.065
Value of articles used by taxpayer as a consumer
17
Use Tax (also complete local tax section III)
05
.065
on which no Washington sales tax has been paid
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
TOTAL STATE SALES & USE TAX
Local Sales Tax (Enter applicable rate of tax)
Code 45
JUNE 2001
DUE DATE: JUNE 25, 2001
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
S
M
T
W
T
F
S
25
5% Penalty is Due After June 25, 2001
Line
1
2
No. Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
10% Penalty is Due After July 31, 2001
3
4
5
6
7
8
9
20% Penalty is Due After August 31, 2001
18
10
11
12
13
14
15
16
If the due date falls on a weekend or legal holiday,
17
18
19
20
21
22
23
19
the due date is extended to the next business day.
24
25
26
27
28
29
30
20
Please fill in this box if you had no business activity.
(see note 6, page 2)
21
This return must be mailed, unless filed electronically with no tax due.
22
Please make check or money order payable to the Washington
State Department of Revenue. Do not send cash or coins.
TOTAL
TOTAL
TAXABLE
For assistance, call (800) 647-7706.
Local Use Tax (Enter applicable rate of tax)
Code 46
Signature
Total Value of Articles must be the same as line 17, column 1, Gross Amount
Ph. (
)
Date
Line
No. Location Code
Value of Articles
Local Rate Tax Due City or Co.
Line
Item
VIII TOTALS
No.
23
Total All Tax Due from page 1
29
24
30
Total All Tax Due from page 2
25
31
Rental Car Tax (attach Rental Car Tax Addendum)
TOTAL VALUE
TOTAL
OF ARTICLES
32
Subtotal (add lines 29-31)
Line
Tax
Code
Taxable Amount
Rate
Tax Due
33
Credit (from page 2, section VII, total credit)
No.
Classification
Region Transit
34
Subtotal (subtract line 33 from line 32)
26
89
.004
Authority (RTA)
Minimum
Penalty
35
$5.00
King County
27
90
.005
36
Interest
Food & Bev
➲
➲
TOTAL AMOUNT OWED
(add lines 34 - 36)
28
Litter Tax
36
.00015
If you qualify, attach penalty waiver request and fill in box
(see note 4, page 2)
REV 40 2406 MAY/01 (2-28-01)
.
Page 1
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial